BY ARUN. MKVM COLLEGE

Introduction

Mental retardation is a state of developmental deficit that begins in childhood and result in significant limitation of intellect and poor adaptation to the demands of every day life. Several terms such as mental handicap, mental deficiency, mental subnormality and so on have been used to denote this condition.

Definition “Mental retardation is defined by deficits in general intellectual functioning and adaptive functioning (APA, 2000).

General intellectual functioning is

measured by an individual’s performance on intelligence quotient (IQ) tests.

Adaptive functioning refers to the person’s ability to adapt to the requirements of daily living and the expectations of his or her age and cultural group.

Meaning Mental retardation is not a disease

but a condition in which the intellectual faculties are never manifested or have never been developed sufficiently to enable the retarded person to acquire such an amount of knowledge as persons of his own age and placed in similar circumstance with him-self are capable of receiving.

Epidemiology About 20 million people with mild an d 4

million with moderate and severe mentally retarded .

Highest incidence in school age children with peak at ages 10 to 12.

Twice as common, in boys and girls.

Classification of mental retardation Four types of mental retardation depending on IQ

and adaptive behavior. (Ability to Perform Self-Care Activities Cognitive/Educational Capabilities Social/ Communication Capabilities Psychomotor Capabilities)

Mild Mental Retardation.Moderate Mental Retardation.Severe Mental Retardation.Profound Mental Retardation.

Mild Mental Retardation: (IQ 50 to 70). Constitutes about 85% of the total

mentally retarded.Motor and sensory deficits are slight.Usually develop normal language abilities

and social behavior.Can achieve academic level up to 6-8th

standard. Usually belong to low socioeconomic,

class.

Moderate Mental Retardation: (IQ 35 to 50) about 10% of all the mentally retarded

come under this category.earlier called as “trainable”.They can be trained to speak and support

themselves by performing semiskilled or unskilled work under supervision.

Severe Mental Retardation: (IQ 20-35) account for about 7% of the mentally

retarded.In the preschool years, their development

is usually greatly slowed.They are called the “dependant”.As adults, they can undertake simple

tasks and engage in limited activities.

Profound Mental Retardation: (IQ below 20) Less than 1% mentally retarded.Very few of them learn to care themselves

completely.Some eventually achieve some simple

speech and social behavior.

Etiological ImplicationsFive major predisposing factors have been

identified:1. Hereditary factors2. Early alterations in embryonic development3. Pregnancy and prenatal factors4. General medical conditions acquired in

infancy orchildhood5. Environmental influences and other mental

disorders.

Hereditary FactorsHereditary factors are implicated as the

cause in approximately 5 percent of the cases.

These factors include inborn errors of metabolism, such as Tay-Sachs disease, phenylketonuria, and hyperglycinemia.

Also included are chromosomal disorders, such as Down syndrome and Klinefelter’s syndrome, and single-gene abnormalities, such as tuberous sclerosis and neurofibromatosis.

Early Alterations in Embryonic Development

Prenatal factors that result in early alterations in embryonic development account for approximately 30 percent of mental retardation cases.

Damages may occur in response to toxicity associated with maternal ingestion of alcohol or other drugs.

Maternal illnessesand infections during pregnancy (e.g., rubella, cytomegalovirus)

Complications of pregnancy (e.g., toxemia, uncontrolled diabetes) also can result in congenital mental retardation

Pregnancy and Perinatal FactorsApproximately 10 percent of cases of mental

retardation are the result of factors that occur during pregnancy (e.g., fetal malnutrition, viral and other infections, and prematurity) or during the birth process.

Examples of the latter include trauma to the head incurred duringthe process of birth, placenta previa or premature separation of the placenta, and prolapse of the umbilical cord.

General Medical Conditions Acquired in Infancy or Childhood

General medical conditions acquired during infancy or childhood account for approximately 5 percent of cases

They include infections, such as meningitis and encephalitis; poisonings, such as from insecticides,

medications, and lead; physical trauma, such as head injuries,

asphyxiation, and hyperpyrexia

Environmental Influences and Other Mental Disorders

Between 15 and 20 percent of cases of mental retardation are attributed to deprivation of nurturance and social, linguistic, and other stimulation, and to severe mental disorders, such as autistic disorder

Disorders Frequent Among Mentally RetardedA.. Physical Disorders

Sensory Disorders (about 20%) Motor Disorders

Psychiatric Disorders (all varieties)SchizophreniaMood DisordersNeurosispersonality Disorders Organic Psychiatric DisordersAutism and Over activity syndromes Behavior

DisordersSexual Problems

Causes of M.RPrenatal causes

InfectionsPhysical DamageIntoxicationsPlacental dysfunctionEndocrine disorders

Intranatal causesBirth asphyxiaProlonged or difficult birthPrematurityKernicterusInstrumental delivery

Postnatal DamageInjuryInfectionIntoxication

Genetic causesChromosomal Abnormalities

Down’s syndromeKlinefelter’s syndromeFragile – X – syndromeTrisomy – 21Turner’s syndrome

Metabolic DisordersAmino acidsLipids CarbohydratesPurines-Lesch-NyansyndromeUrea cycleMucopolysaccharidesMiscellaneous

Gross Disease of Brain Tuberous sclerosis Neurofibromatosis Epilepsy

Cranial Malformations Hydrocephaly Microcephaly

Sociocultural Causes Deprivation of sociocultural stimulation

Psychiatric Conditions Autistic disorder Rett's syndrome Childhood-onset schizophrenia Asperger's syndrome

Clinical PictureMouth - small mouth and teeth, furrowed

tongue (longitudinal cracks and grooves over the tounge), high arched palate.

Eyes-oblique palpebral fissures, epicanthic foldsHead – flat occiputHands – short and broad, curved with fingers,

single transverse crease (single crease extends across the palm of the hand ).

Joints – hyper extensibility or hyper flexibility, hypotonia (low muscle tone), poor Moro reflex

Effects of Mental Retardation on the FamilyDistress, feelings of rejection. Depression, guilt, shame or angerRejection of child.Overindulgence.Social problems.Marital disharmony (in some).Burden of care for their child.Dissatisfaction about medical and social

services (even when they are normal).

Diagnosis of mental retardationHistoryGeneral Physical ExaminationDetailed Neurological ExaminationMental Status ExaminationInvestigations

RoutineUrine examinationBlood TestChromosomal StudiesEndocrinolLiver Function testsEEGCTScan of BrainDevelopmental Assessment

Differential DiagnosisDelayed maturationBlindness or other sensory defects.Childhood psychosis Childhood autismSevere neuroses.Systemic disorders with physical

handicap.Deprived children with insufficient

stimulation.Epilepsy.States due to the side effects of drugs

Management of mental retardation

1. Primary Prevention2. Secondary Prevention3. Tertiary Prevention

Primary PreventionHealth Promotion

Good antenatal care and encouraging deliveries in hospitals under proper supervision and care

Improving the socioeconomic status of the country.

Education of the public to help in early detection of mental retardation and also, to, remove various misconceptions about its causes and treatment.

Facilitating research to identify the causes, and to invent new methods of treatment.

Cont………….Specific Protection

Good parental, natal and postnatal care the pregnant mothers at risk.

Genetic counseling to at risk patients Avoiding childbirths in late age of the motherAvoiding consanguinal marriagesAvoiding marriages of mentally retarded

Secondary Prevention (Early Diagnosis and Treatment)

Early detection and treatment of the preventable disorders

Amniocentesis and medial termination of pregnancy on medical grounds.

Early detection of correctable disorders.Prevent them against abuse

Tertiary Prevention

Disability LimitationTreatment of physical and psychological

problems Institutionalization of severe mentally

retarded or those with psychological problems.

Education (if educable) and training to avoid handicaps.

Physiotherapy to treat the associated deficits.

Rehabilitation

Counseling to ParentsThe causation, prognosis of mental

retardation.To educate mothers and families in caring

for the mentally handicappedSpecial supervision for the physically

handicapped or those severely and profoundly men tally retarded.

Treatment of psychological problems in parents.

HospitalizationIndications

Attention deficit disorders with hyperkinesis

destructive, assaultive behavior.PsychosisOrganic psychosis

Social factorsOver crowdingIncompetent parentsMentally retarded or psychotic parentsSingle parenthoodNo one to look after

Nursing managementImpaired verbal communication related to

delayed development of milestones.Attention deficit related to mental

retardation impaired cognitive function.Self care deficit by difficulty in grooming,

nutrition, hygiene related to impaired cognitive functions.

Impaired health maintenance related to cognitive impairment

Social isolation related to impaired personal relationships

Ineffective coping related to mentally retarded child.

Reference Dr.K.Lalitha,”MENTAL HEALTH AND PSYCHIATRIC NURSING AN INDIAN PERSPECTIVE”, 2nd edition, Bangalore: V.M.G. Book House, 2008,pg no:529-534

Dr.Kapoor.B, “ TEXTBOOK OF PSYCHIATRIC NURSING”, vol II, 1st edition,Delhi: Kumar publishing house,2006, pg

no:208-213

Sreevani R, “A Guide To Mental Health Psychiatric Nursing”, 2nd edition, Jaypee publication, New Delhi. Pg no. 104-108

Assignment Define mental retardation.

Explain about the classification of M.R

List down the causes of M.R

List down the steps involved in the management of M.R

Thank You